Information for HIV positive women

For much of the 25 years that HIV/AIDS has existed in the United States, the disease was thought to impact mainly gay white men. However, today in the U.S. about 25% of new infections are in women, especially women of color, and over 70% of new infections in women occur through heterosexual sex.¹ Here is a brief review of HIV statistics related to women in the United States:²

In 2004, 27% of new HIV/AIDS diagnoses were in women
In 2004, 64% of women living with HIV/AIDS were African American, 19% were white and 15% were Hispanic
In 2002, HIV/AIDS was the leading cause of death among African-American women ages 25 to 34, and the 6th leading cause among all women in this age group

Most of the effects of HIV and AIDS are similar for men and women, but there are some biological and social differences. For women, HIV is transmitted more commonly through heterosexual sex. Certain opportunistic infections associated with HIV are unique to women, such as recurrent vaginal yeast infections, severe pelvic inflammatory disease and cervical cancer. Women's responses to HIV therapy may also differ from those of men. Women may have more difficulty accessing health care, due to factors such as lack of transportation or an added responsibility of caring for others, especially children.³

Current guidelines about when to start treatment are the same for men and women, and are based on viral load and CD4 cell counts. Because of gender differences, some medical experts believe that the guidelines should recommend that women consider starting treatment at lower viral load levels than men.

Others argue that no change is required since the overall health outcome is the same.¹ If you are thinking about starting treatment, it is important to keep track of your test results and talk to your healthcare provider about the best treatment plan for you.

Women tend to be diagnosed with HIV later in the disease than men. Reasons for this may include poor access to health care, women not thinking they are at risk for HIV infection and women not heeding symptoms that could serve as warning signals of HIV infection, such as recurrent yeast infections.¹

In addition, once they know their HIV status, women often postpone medical care due to several barriers including:¹

Limited access to health care due to lack of insurance
Responsibilities such as child care or caring for a sick partner
The stigma associated with HIV
Active substance abuse
Domestic violence
Depression

When women do receive adequate care and treatment in a timely manner, they appear to benefit from HIV meds as much as men.¹ If you are a woman with HIV, it is important to develop and stick to a treatment plan with your healthcare provider to ensure the best possible outcomes. Make sure you are open with your healthcare provider about your lifestyle and schedule so that you can choose an HIV regimen that is best for you.

Another important issue for women with HIV is pregnancy. For an HIV-positive woman who is thinking about having a baby, or is already pregnant, many questions arise. What is the risk of passing HIV to the newborn? Can treatments lower this risk? Are HIV medications safe to take during pregnancy? Obviously, it is very important to tell your healthcare provider if you are pregnant or planning to become pregnant, or if you are breastfeeding.

In the United States, approximately 25% of pregnant HIV-positive women who do not receive any medications pass the virus to their babies. If women do receive combination HIV therapy during pregnancy, however, the risk of HIV transmission to the newborn drops below 2%.¹

For HIV-positive women who are pregnant or are of reproductive age, the U.S. Department of Health and Human Services (DHHS) recommends the following:⁴

The goals of treatment and the reasons for starting medications should be the same as other adults
The medication called efavirenz should be avoided
Prevention of mother-to-child transmission should be an additional treatment goal during pregnancy
Choice of treatment to use should take into account the known safety and effectiveness information of each individual medication during pregnancy

If you are already taking HIV medications, talk with your healthcare provider about the potential risks and benefits to your baby if you decide to continue your treatment regimen during your pregnancy. You and your healthcare provider may decide to change your meds or your medication dose.⁴ In partnership with your healthcare provider, you can decide which medication works best for you. You may be asked to enroll in an antiviral pregnancy registry depending on the medication.

Certain gynecological conditions are more common, more serious and/or more difficult to treat in HIV-positive women than HIV-negative women:¹

Some vaginal infections (including yeast infections)
Bacterial vaginosis
Common sexually transmitted diseases (such as gonorrhea, chlamydia and trichomoniasis)
Herpes simplex virus outbreaks
Pelvic inflammatory disease (PID)
Dysplasia, a pre-cancerous condition in the female reproductive system

It is very important for HIV-positive women to have regular pap smears. A pap smear is a screening test your healthcare provider does to check for changes in the cervix. An abnormal pap smear can indicate inflammation, infection, dysplasia or cancer.²

HIV-positive women are 10 times more likely to have abnormal pap smears than HIV-negative women. These abnormal pap smears are usually associated with low CD4 cell counts and human papilloma virus (HPV), a sexually transmitted disease that can also cause genital warts.¹

The Centers for Disease Control and Prevention (CDC) recommends the following:¹

HIV-positive women have a complete gynecological examination, including a pap smear, when they are first diagnosed or when they first seek prenatal care
HIV-positive women have another pap smear six months later
If both tests are negative, yearly screening is recommended
Women who have had dysplasia in the past should receive a pap smear every six months

1. National Institute of Allergy and Infectious Disease. Fact Sheet: HIV Infection in Women. Retrieved August 2006 from http://www.niaid.nih.gov/factsheets/womenhiv.htm
2. Centers for Disease Control and Prevention (CDC). Retrieved August 2006 from http://www.cdc.gov/hiv/topics/women/surveillance.htm
3. Centers for Disease Control and Prevention (CDC). Retrieved August 2006 from http://www.cdc.gov/hiv/topics/women/index.htm
4. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (a Working Group of the Office of AIDS Research Advisory Council). May 4, 2006.